ISSN 1305-5550 | e-ISSN 2548-0669
Göğüs-Kalp-Damar Anestezi ve Yoğun Bakım Derneği Dergisi - GKD Anest Yoğ Bak Dern Derg: 29 (1)
Cilt: 29  Sayı: 1 - 2023
Full Issue

Sayfa I (265 kere görüntülendi)

Incidence of Chronic Neuropathic Pain After Open-heart Surgery: A Retrospective Cohort Analysis
Senem Girgin, Birzat Emre Gölboyu
doi: 10.14744/GKDAD.2023.29052  Sayfalar 1 - 6 (359 kere görüntülendi)
Objectives: Chronic sternal pain has been reported in 11%–56% of patients 1 year after cardiac surgery with median sternotomy. However, chronic pain after sternotomy can frequently be ignored.
Methods: Patients who received open-heart surgery between January 2020 and June 2022 were included. Data analysis was performed through file scans, hospital data processing system and patient follow-up documents, phone calls, and algology outpatient clinic records. T For the assessment of neuropathic pain, the Turkish version of the pain scale, for which validity and reliability studies were conducted, was employed.
Results: When all patients were analyzed, the incidence of chronic pain was 28.7%, and the incidence of chronic neuropathic pain was 14.7%. There was no difference in age, gender, education level, time after surgery, and smoking. Although the BMI was higher in the group with neuropathic pain when compared, there was no statistically significant difference. The presence of Diabetes Mellitus (DM) diagnosis was statistically significant in the group that created the neuropathic pain group, and no discernible difference was found in terms of other additional diseases. The rate of patients with preoperative angina was discovered to be higher in the neuropathic pain group (p: 0.030). When the type of surgery, urgency, and need for revision were compared, no significant difference was observed between the two groups. When both groups were compared in terms of l the duration of hospital stay was discovered to be longer in the neuropathic pain group (17 [15–19] days, p: 0.046).
Conclusion: The incidence of chronic neuropathic pain was estimated to be 14.7%, and it was shown that the presence of DM, preoperative angina, and the long hospital stay might be factors contributing to the development of chronic neuropathic pain.

Systemic Immune-inflammation Index Predicts Acute Kidney Injury after Cardiac Surgery: A Retrospective Observational Study
Aslıhan Aykut, Emine Nilgün Zengin, Bekir Boğaçhan Akkaya, Nevriye Salman
doi: 10.14744/GKDAD.2023.79664  Sayfalar 7 - 14 (329 kere görüntülendi)
Objectives: Inflammation plays an essential role in the development of postoperative acute kidney injury (AKI) in patients receiving cardiac surgery. The study aims to examine the predictive value of the systemic immune-inflammation index (SII), a new biomarker reflecting systemic inflammation, in the development of AKI following cardiac surgery in patients who had coronary artery bypass grafting (CABG).
Methods: Patients who received CABG operation in 2022 were retrospectively examined. The incidence of AKI 7 days postsurgery using Kidney Disease Improving Global Outcomes criteria was the primary outcome. The patients were classified into the AKI (n=160) and non-AKI groups (n=424). Patients were compared in terms of basic clinical features, operative characteristics, postoperative variables, and hematological indices derived from preoperative complete blood count analysis. The ability of SII to predict AKI was assessed using receiver-operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis was used to determine the independent relationship between the development of SII and AKI.
Results: In this investigation, the incidence of AKI was 25.6%. eGFR, serum albumin, and hemoglobin were significantly lower in the AKI group, whereas body mass index, hypertension, serum creatinine, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and SII were significantly greater. The preoperative SII cutoff of 651.7 predicted AKI with 65.0% sensitivity and 64.9% specificity. The area under the ROC curve was 0.718 (95% confidence interval 0.676–0.760).
Conclusion: Preoperative SII may be a simple, inexpensive, and useful prognostic biomarker in predicting postoperative AKI in patients undergoing CABG.

Enhanced Recovery In Cardiac Surgical Patients With Low Left Ventricular Ejection Fraction: A Controlled Before-and-After Study
İpek Yakın Düzyol, Kemal Saraçoğlu, Hüseyin Şaşkın, Emine Yurt, Mehmet Yılmaz, Çağrı Düzyol, Ayten Saraçoğlu
doi: 10.14744/GKDAD.2023.78055  Sayfalar 15 - 22 (264 kere görüntülendi)
Objectives: The application of Enhanced Recovery After Surgery (ERAS) in cardiac surgery has been increasing in recent years. The goal of this controlled before-and-after study is to compare the postoperative follow-up periods of patients who had low left ventricular ejection fraction and were operated on for coronary artery bypass grafting using the ERAS protocol and the standard protocol (CABG).
Methods: Controlled before-and-after study. A single hospital-based study. Perioperative data from 50 consecutive patients who used the standard protocol (preERAS) were matched with data from 50 consecutive patients in the prospective group (postERAS) which consisted of 50 consecutive patients. Patients with low left ventricular ejection fraction were detected in both groups.
Results: Patient demographics, operation and cross-clamp durations, cross-clamp and CPB, amount of perioperative bleeding, time of extubation, length of stay in the intensive care unit and hospital, and complications were all recorded and compared between groups. The time of extubation was statistically significantly earlier in the posters group (7.2±2.2 h vs. 10.9±6.0 h, p=0.001). Perioperative blood loss was statistically significantly lower in the postERAS group than in the preERAS group (359±56.9 vs. 392±75.8 cc respectively, p=0.028). The patients under posters protocol stayed statistically importantly lower in the intensive care unit (2.1±0.5 days vs. 2.4±0.8 days, respectively p=0.002).
Conclusion: The ERAS pathway was found to be feasible in patients and was associated with shorter extubation time, less perioperative bleeding, and a shorter stay in the intensive care unit and hospital.

Ultrasound-Guided Rhomboid Intercostal Block for Analgesia After Cardiac Surgery: A New Indication for Novel Fascial Plane Block
Burhan Dost, Cengiz Kaya, Semih Murat Yücel, Serkan Tulgar, Alessandro De Cassai, Deniz Karakaya
doi: 10.14744/GKDAD.2023.21548  Sayfalar 23 - 26 (478 kere görüntülendi)
Objectives: Acute postoperative pain is a common complication after cardiac surgery. When not properly regulated, it may have a negative impact on clinical results. One of the novel fascial plane blocks that aims to blockade the lateral cutaneous branches of the thoracic intercostal nerves is the rhomboid intercostal block. In the literature, there is no research of rhomboid intercostal block in cardiac surgery, and a limited number of reports employing this block to analgesia for thoracotomy, scapulothoracic arthrodesis, and lung transplantation. In our research, we aimed to display a case series of bilateral rhomboid intercostal blocks employed as an element of multimodal analgesia in five consecutive patients who underwent cardiac surgery through a median sternotomy.
Methods: Five adult patients who had a rhomboid intercostal block for postoperative analgesia after cardiac surgery were investigated. Within the first 24 hours after surgery, cumulative morphine consumption and pain scores during rest and coughing were assessed.
Results: In the first 24 h after surgery, the median cumulative morphine intake was 4 mg (0–20 mg). Also, the patients' pain scores were less (NRS≤4) at all-time points. There were no opioid-related adverse events or block-related additions in any patient.
Conclusion: As part of multimodal analgesia, the rhomboid intercostal block was thought to help reduce opioid consumption as well as pain scores in cardiac surgery cases.

Evaluation of Healthcare-associated Nosocomial Infections in the Pediatric Cardiovascular Surgery Intensive Care Unit in Türkiye (2012–2021)
Sibel Doğan Kaya, Aysu Türkmen Karaağaç
doi: 10.14744/GKDAD.2023.20438  Sayfalar 27 - 32 (276 kere görüntülendi)
Objectives: The study evaluated the 10-year healthcare-associated infections (HCAI) data in the pediatric cardiovascular surgery intensive care unit (PCVS-ICU).
Methods: The electronic data of 106 patients with HCAI between 2012 and 2021 were retrospectively analyzed for the infection sites, isolated microorganisms, and antibiotic resistance.
Results: 3617 patients with 29155 patient days in our 12-bedded PCVS-ICU were evaluated. There were 64 HCAIs during 2012–2016, comprised of 17 (26.5%) bloodstream infections (BSI), 16 (25%) pneumonia, 13 (20.3%) urinary tract infections (UTI), 8 (12.5%) ventilator-associated pneumonia (VAP), 7 (11.1%) surgical site infection (SSI), and 3 (4.6%) soft-tissue infection (STI). In contrast, 42 HCAIs were observed in 2017–2021, which included 17 (40.4%) BSI, 10 (23.8%) pneumonia, 7 (16.6%) VIP, 4 (9.6%) UTI, 3 (7.2%) SSI, and 1 (2.4%) STI. The most common pathogen was the Candida species. The ventilator usage rate was 2.8 per 8635 ventilator days and 0.42 per 6439 ventilator days in the first and second five years, respectively. The rate of central venous catheter (CVC) use was 2.04 and 0.96 in the first and second five years, respectively.
Conclusion: The most common HCAI was BSI, and the most common isolated pathogen was Candida species within ten years in our PCVS-ICU. The infection rate, CVC, and UC usage rates were decreased, with an increased compliance rate on hand hygiene in the second five years, indicating strict adherence to infection control measures.

Single-Center Outcomes of Vacuum-Assisted Closure Therapy for Mediastinitis After Pediatric Cardiac Surgery
Murat Çiçek, Mehmet Akif Önalan
doi: 10.14744/GKDAD.2023.43660  Sayfalar 33 - 38 (247 kere görüntülendi)
Objectives: Vacuum-assisted closure therapy is useful in treating mediastinitis, which is related to high mortality and morbidity rates after cardiac surgery. This study aimed to present our experience with vacuum-assisted closure therapy in mediastinitis after pediatric cardiac surgery.
Methods: This retrospective review included 10 patients who underwent vacuum-assisted closure therapy for mediastinitis in a single institution from 2020 to 2022. Patients with wound discharge or abscess, sternal dehiscence, fever, and positive wound culture were considered to have mediastinitis. The vacuum sponge was cut at the appropriate size for the mediastinal defect and the skin edges were approximated with prolene sutures. The vacuuming continuously started at −50 mm Hg.
Results: Six (60%) patients were female and the median age during therapy was 1.9 months (range: 0.1–54 months). Five (50%) patients were neonates. The median duration of vacuum-assisted closure therapy was 14.5 days (range: 4–78). The median duration to obtain negative mediastinal culture was 14.5 days (range: 6–76). The sternum could be closed without difficulty in all patients except one who died due to low cardiac output. Hospital mortality occurred in 3 (30%) patients who needed extracorporeal membrane oxygenation support postoperatively. The median duration of follow-up was 10 months (range: 2–28).
Conclusion: Mediastinitis is an important problem associated with high morbidity and mortality rates after pediatric cardiac surgery. Data suggest that vacuum-assisted closure therapy can safely treat mediastinal infections without recurrence.

Difference Among Perioperative Factors Related to Ultra-Fast Track Extubation After Fontan Completion
Mehmet Bicer, Şima Kozan, Kamil Darçın, Seçil Çetin, Murat Tanyıldız, Ömer Özden, Mete Han Kızılkaya, Ender Ödemiş
doi: 10.14744/GKDAD.2023.46503  Sayfalar 39 - 44 (222 kere görüntülendi)
Objectives: The immediate extubation technique in patients undergoing a Fontan operation is commonly used to reduce the negative effects of positive-pressure ventilation on pulmonary blood flow and provide a hemodynamic advantage. This study aimed to determine the correlation between the perioperative characteristics of patients undergoing a Fontan operation and the success of fast track extubation.
Methods: Perioperative data from patients from all age groups undergoing a Fontan operation were retrospectively analyzed and correlated with their extubation time.
Results: A table extubation was performed on 72.7% of patients undergoing a Fontan operation. Age, presence of fenestration, conduit localization, heterotaxy, cross and bypass durations, and success of ultra-fast track extubation have no significant correlation.
Conclusion: Ultra-fast track extubation strategy facilitated the hemodynamic adaptation of patients to the Fontan circulation. However, the Fontan population has little variation in early extubation characteristics.

The Effect of CRP/Albumin, Platelet/Lymphocyte, SOFA, and APACHE II in Predicting Mortality in Covid-19 Patients in Intensive Care Unit
Ümit Turda, Özlem Deligöz, Osman Ekinci
doi: 10.14744/GKDAD.2023.63383  Sayfalar 45 - 50 (258 kere görüntülendi)
Objectives: It is important to predict the prognosis during hospital admission of Covid-19 patients. The purpose of this study was to see how CRP/Albumin (CAR) and Platelet/Lymphocyte (PLR) ratios, obtained from patients in the intensive care unit (ICU) within the first 24 hours of their hospi-talization with a Covid-19 diagnosis, predictmortality and how they correlated with acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA).
Methods: Using hospital records, records of 83 patients hospitalized in the ICU with a diagnosis of Covid-19 between 11.03.2020 and 01.01.2021 were retrospectively analyzed. Patients were divided into two groups discharged (Group I) and exits (ex) group (Group II). CAR and PLR were recorded during the first 24 hours of ICU admission, and APACHE II and SOFA scores were computed. The calculated CAR and PLR were correlated with APACHE II and SOFA scores and their association with mortality was investigated.
Results: SOFA, APACHE II, PLO, and age were higher, and albumin was lower in patients in the mortal course (p<0.05). ROC analysis revealed that APACHE II and SOFA scores could be employed to estimate mortality.
Conclusion: We believe that APACHE II and SOFA scores can be used to predict mortality in patients admitted to the ICU due to Covid-19, whereas CRP/Albumin and Platelet/Lymphocyte ratios cannot.

Comparing Total Parenteral Nutrition with Other Methods in Treating Chylotorax
Mehmet Kadir Bartın
doi: 10.14744/GKDAD.2023.57855  Sayfalar 51 - 56 (560 kere görüntülendi)
Objectives: This study aimed to examine the role of total parenteral nutrition in the treatment of chilotorax.
Methods: A total of 1149 patients who were operated for esophagus cancer were screened between 2010 and 2021. Of these patients, 49 were identified with chilorotax. Patients were divided into three groups. Some of these were treated surgically (first group) and through conventional approaches such as plorodesis, and somatostatin (second group). The only method of treatment used for the remaining patients was total parenteral feeding (third group). These three groups were statistically compared using clinical data to demonstrate that total parenteral nutrition is as effective as other treatments for chilotorax.
Results: A total of 1144 patients who received surgical treatment for esophageal cancer were analyzed. Chilotorax was used to diagnose 49 of these patients. Fewer deaths and complications occurred in the third group who were treated with just total parenteral nutrition. When the groups were compared using post hoc multiple comparison tests, based on the length of stay in the hospital after diagnosis and treatment initiation, it was discovered that; the average length of stay in the hospital in group 3 was less than the other two groups.
Conclusion: The use of total parenteral nutrition alone or in conjunction with surgical and another interventional processes in the treatment of chylothorax importantly reduces the risk of difficulties as well as the death rate. In all patients with chylothorax, parenteral nutrition should be included to the treatment protocol.

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